Monoclonal antibodies in prophylactic immunosuppression after liver transplantation. A randomized controlled trial comparing OKT3 and anti-IL-2 receptor monoclonal antibody LO-Tact-1.

A prospective trial was conducted to assess the efficacy of induction immunosuppression with antilymphocyte monoclonal antibodies in 129 primary liver transplant patients who were randomly divided into three groups according to immunosuppression during the first 10 days post-OLT: triple drug therapy only (TDIS: cyclosporine, steroids, azathioprine) (group I: n = 42); TDIS with a 10-day course of OKT3 (group II: n = 44); and LO-Tact-1 (anti-IL-2 receptor mAb) (group III: n = 43). Biopsy-proved acute rejection (AR) was treated using the same biopsy-guided protocol in the 3 groups. One-year patient survival rates were 67%, 84%, and 93% in groups I, II, and III, respectively (I vs. II, NS; I vs. III, P = 0.001; II vs. III, P = 0.044). Incidences of AR were studied in the subgroup of 100 patients who were exposed to the risk of developing rejection, with an overall rate of 89% during the first 3 months post-OLT, similar in the 3 groups. However, incidences of steroid-resistant rejection diagnosed during the 10 first days post-OLT were 54%, 24%, and 34% in groups I, II, and III and 46%, 26%, and 11%, respectively, during the 10-90 days interval. Sixteen patients with CMV had received OKT3, whereas the 5 remaining CMV cases had not (P = 0.019). In summary: (1) mAbs did not modify crude incidence of AR; (2) in the early period (< 10 days), TDIS immunoprophylaxis combined with OKT3 was more efficient than TDIS alone; (3) when compared with groups I and II, LO-Tact-1 apparently better prevented steroid-resistant rejection during the 10-90 days post-OLT; (4) OKT3 significantly increased incidence of CMV infection. In conclusion, TDIS with LO-Tact-1 seemed to achieve the better risk-benefit ratio in induction immunosuppression after OLT.

Monoclonal antibodies detect M-protein epitopes on the surface of influenza virions.

Various data obtained with activable hydrophobic probes, proteolytic treatments and anti M-protein polyclonal antibodies strongly suggest that M-protein of influenza A is an integral part of the lipid bilayer of native virions and somehow spans at the surface of the virions. Therefore we have looked for the presence of M-protein epitopes on the surface of influenza A virion by using four type A M-protein monoclonal antibodies. We developed a specific and sensitive competition ELISA where intact virions, dodecyl-sulfate disrupted virions and spikeless particles obtained after proteolytic treatment with caseinase C were used to test their ability to inhibit the reaction between these monoclonal antibodies and pure M-protein. Intact virions or SDS disrupted virions prevented three monoclonal antibodies from reacting with the M-protein. Spikeless particles also inhibited the specific binding of two of these antibodies, whereas the other fourth antibody was inhibited by contact with SDS disrupted particles only. Data presented show that at least three distinct M-protein epitopes were detected, of which at least two are exposed on the surface of intact virions. Of these two epitopes, one is inactivated by the proteolytic treatment. The third epitope could only react with its monoclonal antibody when the virus particles were solubilized with SDS. This work provides a clear demonstration that a substantial part of the M-protein spans the lipid bilayer and that the rest, protected by lipids, resists proteolytic enzymes and is prevented from binding with anti M-protein monoclonal antibodies.

Human IgG and Streptococcus mutans SR protein contain cross-reactive epitopes.

Antigen B, a glycoprotein present on the cell surface of "mutans streptococci," mediates bacterial adherence to teeth surfaces and has been implicated in cross-reactivity with human heart components. Elevated levels of anti-IgG antibodies were generally found in sera of rabbits immunized with protein SR, a B-related protein from Streptococcus mutans serogroup f, or recombinant protein SR (rSR). These anti-IgG antibodies could be involved in the previously mentioned heart cross-reactivities. Results from immunoblots and ELISA analyses demonstrate that these anti-IgG antibodies recognize common epitopes on SR, rSR, and human IgG2 and IgG4 probably located on the Fab region. Furthermore, control experiments with biotinylated human IgG show that the cross-reactions between IgG and SR were not mediated by an FcR mechanism. Direct competition between rSR and human IgG in binding to anti-IgG or anti-SR antibodies confirm that S. mutans SR protein possesses Ag mimicry with human IgG. Our studies provide some evidence that S. mutans SR protein and human IgG H chains share autoimmune epitopes which could play a role in the induction of anti-IgG antibodies and therefore could explain the enhancement of anti-IgG antibody levels observed in rabbits immunized with either S. mutans whole cells or purified B-related Ag.